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McCoy M, Shorting T, Mysore VK, Fitzgibbon E, Rice J, Savigny M, Weiss M, Vincent D, Hagarty M, MacLeod KK, Ernecoff NC, Pattison R, Kornberg M, Bruni A, Bush SH, Kuluski K, Fiset V, Li C, Parsons HA, Lalumière G, Connolly T, Webber C, Isenberg SR. Advancing the Care Experience for patients receiving Palliative care as they Transition from hospital to Home (ACEPATH): Codesigning an intervention to improve patient and family caregiver experiences. Health Expect 2024; 27:e14002. [PMID: 38549352 PMCID: PMC10979115 DOI: 10.1111/hex.14002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Returning home from the hospital for palliative-focused care is a common transition, but the process can be emotionally distressing and logistically challenging for patients and caregivers. While interventions exist to aid in the transition, none have been developed in partnership with patients and caregivers. OBJECTIVE To undergo the initial stages of codesign to create an intervention (Advancing the Care Experience for patients receiving Palliative care as they Transition from hospital to Home [ACEPATH]) to improve the experience of hospital-to-home transitions for adult patients receiving palliative care and their caregiver(s). METHODS The codesign process consisted of (1) the development of codesign workshop (CDW) materials to communicate key findings from prior research to CDW participants; (2) CDWs with patients, caregivers and healthcare providers (HCPs); and (3) low-fidelity prototype testing to review CDW outputs and develop low-fidelity prototypes of interventions. HCPs provided feedback on the viability of low-fidelity prototypes. RESULTS Three patients, seven caregivers and five HCPs participated in eight CDWs from July 2022 to March 2023. CDWs resulted in four intervention prototypes: a checklist, quick reference sheets, a patient/caregiver workbook and a transition navigator role. Outputs from CDWs included descriptions of interventions and measures of success. In April 2023, the four prototypes were presented in four low-fidelity prototype sessions to 20 HCPs. Participants in the low-fidelity prototype sessions provided feedback on what the interventions could look like, what problems the interventions were trying to solve and concerns about the interventions. CONCLUSION Insights gained from this codesign work will inform high-fidelity prototype testing and the eventual implementation and evaluation of an ACEPATH intervention that aims to improve hospital-to-home transitions for patients receiving a palliative approach to care. PATIENT OR PUBLIC CONTRIBUTION Patients and caregivers with lived experience attended CDWs aimed at designing an intervention to improve the transition from hospital to home. Their direct involvement aligns the intervention with patients' and caregivers' needs when transitioning from hospital to home. Furthermore, four patient/caregiver advisors were engaged throughout the project (from grant writing through to manuscript writing) to ensure all stages were patient- and caregiver-centred.
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Affiliation(s)
| | | | - Vinay Kumar Mysore
- Parsons School of Design, The New SchoolNew YorkNew YorkUSA
- OpenBoxBrooklynNew YorkUSA
| | | | - Jill Rice
- Bruyère Research InstituteOttawaOntarioCanada
- Bruyère Continuing CareOttawaOntarioCanada
- Department of Medicine, Division of Palliative CareUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | | | | | | | - Meaghen Hagarty
- The Ottawa HospitalOttawaOntarioCanada
- Bruyère Continuing CareOttawaOntarioCanada
| | - Krystal Kehoe MacLeod
- Bruyère Research InstituteOttawaOntarioCanada
- Department of Medicine, Division of Palliative CareUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
| | | | | | | | | | - Shirley H. Bush
- Bruyère Research InstituteOttawaOntarioCanada
- Department of Medicine, Division of Palliative CareUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Kerry Kuluski
- Institute for Better Health, Trillium Health PartnersMississaugaOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Valerie Fiset
- Champlain Hospice Palliative Care ProgramOttawaOntarioCanada
- School of Nursing, University of OttawaOttawaOntarioCanada
| | - Cecilia Li
- The Ottawa HospitalOttawaOntarioCanada
- Bruyère Continuing CareOttawaOntarioCanada
- Department of Medicine, Division of Palliative CareUniversity of OttawaOttawaOntarioCanada
| | - Henrique A. Parsons
- The Ottawa HospitalOttawaOntarioCanada
- Department of Medicine, Division of Palliative CareUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Geneviève Lalumière
- Bruyère Continuing CareOttawaOntarioCanada
- Regional Palliative Consultation Team (RPCT)OttawaOntarioCanada
| | - Tara Connolly
- Accessibility InstituteCarleton UniversityOttawaOntarioCanada
| | - Colleen Webber
- Bruyère Research InstituteOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Sarina R. Isenberg
- Bruyère Research InstituteOttawaOntarioCanada
- Department of Medicine, Division of Palliative CareUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
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Mercadante S, Bruera E. Acute palliative care units: characteristics, activities and outcomes - scoping review. BMJ Support Palliat Care 2023; 13:386-392. [PMID: 36653151 DOI: 10.1136/spcare-2022-004088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
Acute palliative care units (APCUs) are lacking in most cancer hospitals and even when palliative care units are present, they are predominantly based on a traditional hospice-like model for patients with short life expectancy. This scoping review examined the papers assessing the activities of APCU. Data from literature regarding APCU characteristics, activities and outcomes have shown important differences among different countries.In comparison with existing data on traditional hospices, APCU provided a whole range of palliative care interventions, from an early treatment of pain and symptoms at time diagnosis and during the oncological treatment, up to the advanced stage of disease when they may favour the transition to the best supportive care or palliative care only, also indicating the best palliative care service that may fits the clinical and social condition of individuals. Large differences in the characteristics of such units, including hospital stay and mortality, have been evidenced, in some cases resembling those of a traditional hospice. It likely that in some countries such units supply the lack of other palliative care services.Further studies on APCUs are needed, even on other outcome processes, to provide a more precise identification among the palliative care settings, which should not interchangeable, but complimentary to offer the full range of activities to be activated according to the different needs of the patients.
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Affiliation(s)
- Sebastiano Mercadante
- Main regional center for pain relief and supportive/palliative care, La Maddalena Cancer center, Palermo, Italy
| | - Eduardo Bruera
- Department of supportive care, MD Anderson, Houston, Texas, USA
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3
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Thelen M, Brearley SG, Walshe C. A grounded theory of interdependence between specialist and generalist palliative care teams across healthcare settings. Palliat Med 2023; 37:1474-1483. [PMID: 37691459 DOI: 10.1177/02692163231195989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Individuals with palliative care needs face increased risk of discontinuity of care as they navigate between healthcare settings, locations and practitioners which can result in poor outcomes. Little is known about interactions that occur between specialist and generalist palliative care teams as patients are transition from hospital to community-based care after hospitalisation. AIM To understand what happens between inpatient specialist palliative care teams and the generalist teams who provide post-discharge palliative care for shared patients. DESIGN A constructivist grounded theory approach, using semi-structured interviews and constant comparative analysis, including coding, memo-writing and diagram construction. SETTINGS/PARTICIPANTS Interviews (n = 21) with specialist palliative care clinicians and clinicians in other specialties providing generalist palliative care. Specialists had training in palliative care and worked in specialty palliative care practices; other clinicians worked in primary care or oncology and did not have specialised palliative care training. RESULTS A grounded theory of interdependence between specialist and generalist palliative care teams across healthcare settings was constructed. Two states of inter-team functioning were found which related to how teams perceived themselves: separate teams or one cross-boundary team. Three conditions influenced these two states of inter-team functioning: knowing the other team; communicating intentionally; and acknowledging and valuing the role of the other team. CONCLUSIONS Teams need to explicitly consider and agree their mode of functioning, and enact changes to enhance knowledge of the team, intentional communication and valuing other teams' contributions. Future research is needed to test or expand this theory across a range of cultures and contexts.
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Affiliation(s)
- Mary Thelen
- Mayo Clinic Health System, Northwest Wisconsin, Eau Claire, WI, USA
| | - Sarah G Brearley
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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4
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van Doorne I, Mokkenstorm K, Willems D, Buurman B, van Rijn M. The perspectives of in-hospital healthcare professionals on the timing and collaboration in advance care planning: A survey study. Heliyon 2023; 9:e14772. [PMID: 37095949 PMCID: PMC10121622 DOI: 10.1016/j.heliyon.2023.e14772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 04/26/2023] Open
Abstract
Background Hospital admissions are common in the last phase of life. However, palliative care and advance care planning (ACP) are provided late or not at all during hospital admission. Aim To provide insight into the perceptions of in-hospital healthcare professionals concerning current and ideal practice and roles of in-hospital palliative care and advance care planning. Methods An electronic cross-sectional survey was send 398 in-hospital healthcare professionals in five hospitals in the Netherlands. The survey contained 48 items on perceptions of palliative care and ACP. Results We included non-specialists who completed the questions of interest, resulting in analysis of 96 questionnaires. Most respondents were nurses (74%). We found that current practice for initiating palliative care and ACP was different to what is considered ideal practice. Ideally, ACP should be initiated for almost every patient for whom no treatment options are available (96.2%), and in case of progression and severe symptoms (94.2%). The largest differences between current and ideal practice were found for patients with functional decline (Current 15.2% versus Ideal 78.5%), and patients with an estimated life expectancy <1 year (Current 32.6% versus ideal 86.1%). Respondents noted that providing palliative care requires collaboration, however, especially nurses noted barriers like a lack of inter-professional consensus. Conclusions The differences between current and ideal practice demonstrate that healthcare professionals are willing to improve palliative care. To do this, nurses need to increase their voice, a shared vision of palliative care and recognition of the added value of working together is needed.
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Affiliation(s)
- I. van Doorne
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Corresponding author. Amsterdam University Medical Center, University of Amsterdam Department of Internal Medicine, Section of Geriatric Medicine, Room D3-335 Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - K. Mokkenstorm
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - D.L. Willems
- Amsterdam UMC Location University of Amsterdam, General Practice, Section of Medical Ethics, Meibergdreef 9, Amsterdam, the Netherlands
| | - B.M. Buurman
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Boelelaan 1117, Amsterdam, the Netherlands
| | - M. van Rijn
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Boelelaan 1117, Amsterdam, the Netherlands
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5
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Scott EL, Funk LM. Cumulative Disempowerment: How Families Experience Older Adults' Transitions into Long-Term Residential Care. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:433-455. [PMID: 35993142 DOI: 10.1080/01634372.2022.2113489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Although emerging research links family experiences with long-term residential care (LTRC) transitions to structural features of health care systems, existing scholarship inadvertently tends to represent the transition as an individual problem to which families need to adjust. This secondary qualitative analysis of 55 interviews with 22 family members caring for an older adult engages a critical gerontological lens. A concept of cumulative, structural empowerment informs this analysis of families' experiences across a broad continuum of older adults' moves into LTRC. Leading up to transitions, families have little power over home care services, and family members have little control over their involvement in care provision. Some families respond by making choices to refuse publicly provided service options, therein both resisting and reinforcing broader relations of power. Expectations for family involvement in LTRC placement decisions were incongruent with some families' experiences, reinforcing a sense of powerlessness compounded by the speed with which these decisions needed to be made. A broad temporal analysis of transitions highlights LTRC transitions as a process of cumulative family disempowerment connected to broader formal care structures alongside emphases on aging in place and familialism that characterize LTRC as the option of last resort.
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Affiliation(s)
- Erin L Scott
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Laura M Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, Canada
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6
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Hafid A, Howard M, Webber C, Gayowsky A, Scott M, Jones A, Hsu AT, Tanuseputro P, Downar J, Conen K, Manuel D, Isenberg SR. Describing settings of care in the last 100 days of life for cancer decedents: a population-based descriptive study. Cancer Med 2023; 12:4809-4820. [PMID: 36281530 PMCID: PMC9972173 DOI: 10.1002/cam4.5291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Few studies have described the settings cancer decedents spend their end-of-life stage, with none considering homecare specifically. We describe the different settings of care experienced in the last 100 days of life by individuals with cancer and how settings of care change as they approached death. METHODS A retrospective cohort study from January 2013 to December 2017, of decedents whose primary cause of death was cancer, using linked population-level health administrative datasets in Ontario, Canada. RESULTS Decedents 125,755 were included in our cohort. The average age at death was 73, 46% were female, and 14% resided in rural regions. And 24% died of lung cancer, 7% breast, 7% colorectal, 7% pancreatic, 5% prostate, and 50% other cancers. In the last 100 days of life, decedents spent 25.9 days in institutions, 25.8 days receiving care in the community, and 48.3 days at home without any care. Individuals who died of lung and pancreatic cancers spent the most days at home without any care (52.1 and 52.6 days), while individuals who died of prostate and breast cancer spent the least days at home without any care (41.6 and 45.1 days). Regardless of cancer type, decedents spent fewer days at home and more days in institutions as they approached death, despite established patient preferences for an end-of-life experience at home. CONCLUSIONS In the last 100 days of life, cancer decedents spent most of their time in either institutions or at home without any care. Improving homecare services during the end-of-life may provide people dying of cancer with a preferred dying experience.
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Affiliation(s)
- Abe Hafid
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,ICES uOttawa, Ottawa, Canada
| | | | - Mary Scott
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada
| | - Aaron Jones
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,ICES uOttawa, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - James Downar
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Katrin Conen
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Doug Manuel
- Ottawa Hospital Research Institute, Ottawa, Canada.,ICES uOttawa, Ottawa, Canada.,Department of Family Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Sarina R Isenberg
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
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7
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Szilcz M, Wastesson JW, Morin L, Calderón-Larrañaga A, Lambe M, Johnell K. Potential overtreatment in end-of-life care in adults 65 years or older dying from cancer: applying quality indicators on nationwide registries. Acta Oncol 2022; 61:1437-1445. [PMID: 36495144 DOI: 10.1080/0284186x.2022.2153621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Quality indicators are frequently used to measure the quality of care at the end of life. Whether quality indicators of potential overtreatment (i.e., when the risks outweigh the benefits) at the end of life can be reliably applied to routinely collected data remains uncertain. This study aimed to identify quality indicators of overtreatment at the end of life in the published literature and to investigate their tentative prevalence among older adults dying with solid cancer. MATERIALS AND METHODS Retrospective cohort study of decedents including all older adults (≥65 years) who died with solid cancer between 1 January 2013 and 31 December 2015 (n = 54,177) in Sweden. Individual data from the National Cause of Death Register were linked with data from the Total Population Register, the National Patient Register, and the Swedish Prescribed Drug Register. Quality indicators were applied for the last one and three months of life. RESULTS From a total of 145 quality indicators of overtreatment identified in the literature, 82 (57%) were potentially operationalisable with routine administrative and healthcare data in Sweden. Unidentifiable procedures and hospital drug treatments were the reason for non-operationalisability in 52% of the excluded indicators. Among the 82 operationalisable indicators, 67 measured overlapping concepts. Based on the remaining 15 unique indicators, we tentatively estimated that overall, about one-third of decedents received at least one treatment or procedure indicative of 'potential overtreatment' during their last month of life. CONCLUSION Almost half of the published overtreatment indicators could not be measured in routine administrative and healthcare data in Sweden due to a lack of means to capture the care procedure. Our tentative estimates suggest that potential overtreatment might affect one-third of cancer decedents near death. However, quality indicators of potential overtreatment for specific use in routinely collected data should be developed and validated.
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Affiliation(s)
- Máté Szilcz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas W Wastesson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Lucas Morin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Inserm CIC 1431, University Hospital of Besançon, Besançon, France
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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de Graaf E, van der Baan F, Grant MP, Verboeket C, van Klinken M, Jobse A, Ausems M, Leget C, Teunissen S. Hospice Care Access: a national cohort study. BMJ Support Palliat Care 2022:bmjspcare-2022-003579. [PMID: 36307176 DOI: 10.1136/spcare-2022-003579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Hospice care in the Netherlands is provided in three different types of hospice facilities: volunteer-driven hospices (VDH), stand-alone hospices (SAHs) and hospice unit nursing homes (HU). The organisational structures range from care directed by trained volunteers in VDH to care provided by multiprofessional teams in SAH and HU units.This study aims to characterise the patient populations who access Dutch hospices and describe the patient profiles in different hospice types. METHODS A retrospective cohort study using clinical records of adult hospice inpatients in 2017-2018 from a random national sample of hospices. RESULTS In total 803 patients were included from 51 hospices, mean age 76.1 (SD 12.4). 78% of patients had a primary diagnosis of cancer, 3% identified as non-Dutch cultural background and 17% were disorientated on admission. At admission, all patients were perceived to have physical needs. Psychological needs were reported in 37%, 36% and 34%, social needs by 53%, 52% and 62%, and existential needs by 23%, 30% and 18% of patients in VDH, SAH, HU units, respectively. 24%, 29% and 27% of patients from VDHs, SAHs and HUs had care needs in three dimensions, and 4%, 6% and 3% in all four dimensions. CONCLUSIONS People who access Dutch hospices predominantly have cancer, and have a range of physical, psychological, social and existential needs, without substantial differences between hospice types. Patients with non-malignant disease and non-Dutch cultural backgrounds are less likely to access hospice care, and future policy would ideally focus on facilitating their involvement.
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Affiliation(s)
- Everlien de Graaf
- Center of Expertise in Palliative Care, Department of General Practice, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Frederieke van der Baan
- Center of Expertise in Palliative Care, Department of General Practice, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Matthew Paul Grant
- Center of Expertise in Palliative Care, Department of General Practice, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Cathelijne Verboeket
- Center of Expertise in Palliative Care, Department of General Practice, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Merel van Klinken
- Center of Expertise in Palliative Care, Department of General Practice, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Adri Jobse
- Center of Expertise in Palliative Care, Department of General Practice, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Marieke Ausems
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Utrecht, The Netherlands
| | - Saskia Teunissen
- Center of Expertise in Palliative Care, Department of General Practice, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
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Barriers and facilitators to multidimensional symptom management in palliative care: A focus group study among patient representatives and clinicians. Palliat Support Care 2022:1-12. [PMID: 36177886 DOI: 10.1017/s147895152200133x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES It is widely acknowledged that co-occurring symptoms in patients with a psychosocial and spiritual aspects should also be considered. However, this multidimensional approach is difficult to integrate into daily practice, especially for generalist clinicians not specialized in palliative care. We aimed to identify the barriers and facilitators to multidimensional symptom management. METHODS Focus group meetings were conducted with the following stakeholders: (1) patient representatives, (2) generalist community nurses, (3) generalist hospital nurses, (4) general practitioners, (5) generalist hospital physicians, and (6) palliative care specialists. Audiotapes were transcribed verbatim and thematically analyzed. RESULTS Fifty-one participants (6-12 per group) reported barriers and facilitators with 3 main themes: multidimensional symptom assessment, initiating management of nonphysical problems, and multidisciplinary collaboration. As barriers, generalist clinicians and palliative care specialists reported that generalist clinicians often lack the communication skills to address nonphysical problems and are unaware of available resources for multidimensional symptom management. Palliative care specialists felt that generalist clinicians may be unaware that assessing nonphysical problems is important and focus on pharmacological interventions. Generalist nurses and palliative care specialists indicated that hierarchical difficulties between them and generalist physicians are barriers to multidisciplinary collaboration. Reported facilitators included using symptom assessment scales and standardized questions on nonphysical problems. SIGNIFICANCE OF RESULTS Generalist clinicians can be supported by improving their communication skills, increasing their awareness of available resources for multidimensional symptom management, and by using a standardized approach to assess all 4 dimensions of palliative care.
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10
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Driller B, Talseth-Palmer B, Hole T, Strømskag KE, Brenne AT. Cancer patients spend more time at home and more often die at home with advance care planning conversations in primary health care: a retrospective observational cohort study. Palliat Care 2022; 21:61. [PMID: 35501797 PMCID: PMC9063101 DOI: 10.1186/s12904-022-00952-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/19/2022] [Indexed: 12/05/2022] Open
Abstract
Background Spending time at home and dying at home is advocated to be a desirable outcome in palliative care (PC). In Norway, home deaths among cancer patients are rare compared to other European countries. Advance care planning (ACP) conversations enable patients to define goals and preferences, reflecting a person’s wishes and current medical condition. Method The study included 250 cancer patients in the Romsdal region with or without an ACP conversation in primary health care who died between September 2018 and August 2020. The patients were identified through their contact with the local hospital, cancer outpatient clinic or hospital-based PC team. Results During the last 90 days of life, patients who had an ACP conversation in primary health care (N=125) were mean 9.8 more days at home, 4.5 less days in nursing home and 5.3 less days in hospital. Having an ACP conversation in primary health care, being male or having a lower age significantly predicted more days at home at the end of life (p< .001). Patients with an ACP conversation in primary health care where significantly more likely to die at home (p< .001) with a four times higher probability (RR=4.5). Contact with the hospital-based PC team was not associated with more days at home or death at home. Patients with contact with the hospital-based PC team were more likely to have an ACP conversation in primary health care. Conclusion Palliative cancer patients with an ACP conversation in primary health care spent more days at home and more frequently died at home. Data suggest it is important that ACP conversations are conducted in primary health care setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00952-1.
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11
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Leniz J, Henson LA, Potter J, Gao W, Newsom-Davis T, Ul-Haq Z, Lucas A, Higginson IJ, Sleeman KE. Association of primary and community care services with emergency visits and hospital admissions at the end of life in people with cancer: a retrospective cohort study. BMJ Open 2022; 12:e054281. [PMID: 35197345 PMCID: PMC8867349 DOI: 10.1136/bmjopen-2021-054281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To examine the association between primary and community care use and measures of acute hospital use in people with cancer at the end of life. DESIGN Retrospective cohort study. SETTING We used Discover, a linked administrative and clinical data set from general practices, community and hospital records in North West London (UK). PARTICIPANTS People registered in general practices, with a diagnosis of cancer who died between 2016 and 2019. PRIMARY AND SECONDARY OUTCOME MEASURES ≥3 hospital admissions during the last 90 days, ≥1 admissions in the last 30 days and ≥1 emergency department (ED) visit in the last 2 weeks of life. RESULTS Of 3581 people, 490 (13.7%) had ≥3 admissions in last 90 days, 1640 (45.8%) had ≥1 admission in the last 30 days, 1042 (28.6%) had ≥1 ED visits in the last 2 weeks; 1069 (29.9%) had more than one of these indicators. Contacts with community nurses in the last 3 months (≥13 vs <4) were associated with fewer admissions in the last 30 days (risk ratio (RR) 0.88, 95% CI 0.90 to 0.98) and ED visits in the last 2 weeks of life (RR 0.79, 95% CI 0.68 to 0.92). Contacts with general practitioners in the last 3 months (≥11 vs <4) was associated with higher risk of ≥3 admissions in the last 90 days (RR 1.63, 95% CI 1.33 to 1.99) and ED visits in the last 2 weeks of life (RR 1.27, 95% CI 1.10 to 1.47). CONCLUSIONS Expanding community nursing could reduce acute hospital use at the end of life and improve quality of care.
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Affiliation(s)
- Javiera Leniz
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Lesley A Henson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Jean Potter
- Department of Palliative Care, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, Greater London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Tom Newsom-Davis
- Oncology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Zia Ul-Haq
- Discover-Now, Imperial College Health Partners, London, UK
| | - Amanda Lucas
- Discover-Now, Imperial College Health Partners, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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12
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Aworinde J, Ellis‐Smith C, Gillam J, Roche M, Coombes L, Yorganci E, Evans CJ. How do person‐centered outcome measures enable shared decision‐making for people with dementia and family carers?—A systematic review. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12304. [PMID: 35676942 PMCID: PMC9169867 DOI: 10.1002/trc2.12304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
Abstract
Objectives To identify published evidence on person‐centered outcome measures (PCOMs) used in dementia care and to explore how PCOMs facilitate shared decision‐making and improve outcomes of care. To build a logic model based on the findings, depicting linkages with PCOM impact mechanisms and care outcomes. Design Mixed‐methods systematic review. We searched PsycINFO, MEDLINE, CINAHL, and ASSIA from databases and included studies reporting experiences and/or impact of PCOM use among people with dementia, family carers, and/or practitioners. Groen Van de Ven's model of collaborative deliberation informed the elements of shared decision‐making in dementia care in the abstraction, analysis, and interpretation of data. Data were narratively synthesized to develop the logic model. Setting Studies were conducted in long‐term care, mixed settings, emergency department, general primary care, and geriatric clinics. Participants A total of 1064 participants were included in the review. Results Ten studies were included. PCOMs can facilitate shared decision‐making through “knowing the person,” “identifying problems, priorities for care and treatment and goal setting,” “evaluating decisions”, and “implementation considerations for PCOM use.” Weak evidence on the impact of PCOMs to improve communication between individuals and practitioners, physical function, and activities of daily living. Conclusions PCOMs can enable shared decision‐making and impact outcomes through facilitating collaborative working between the person's network of family and practitioners to identify and manage symptoms and concerns. The constructed logic model demonstrates the key mechanisms to discuss priorities for care and treatment, and to evaluate decisions and outcomes. A future area of research is training for family carers to use PCOMs with practitioners.
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Affiliation(s)
- Jesutofunmi Aworinde
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation King's College London London UK
| | - Clare Ellis‐Smith
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation King's College London London UK
| | - Juliet Gillam
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation King's College London London UK
| | - Moïse Roche
- Division of Psychiatry University College London London UK
| | - Lucy Coombes
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation King's College London London UK
- The Royal Marsden NHS Foundation Trust Sutton UK
| | - Emel Yorganci
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation King's College London London UK
| | - Catherine J. Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation King's College London London UK
- Sussex Community NHS Foundation Trust Brighton UK
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13
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Guo P, Pinto C, Edwards B, Pask S, Firth A, O'Brien S, Murtagh FE. Experiences of transitioning between settings of care from the perspectives of patients with advanced illness receiving specialist palliative care and their family caregivers: A qualitative interview study. Palliat Med 2022; 36:124-134. [PMID: 34477022 PMCID: PMC8793309 DOI: 10.1177/02692163211043371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transitions between care settings (hospice, hospital and community) can be challenging for patients and family caregivers and are often an under-researched area of health care, including palliative care. AIM To explore the experience of transitions between care settings for those receiving specialist palliative care. DESIGN Qualitative study using thematic analysis. SETTING/PARTICIPANTS Semi-structured interviews were conducted with adult patients (n = 15) and family caregivers (n = 11) receiving specialist palliative care, who had undergone at least two transitions. RESULTS Four themes were identified. (1) Uncertainty about the new care setting. Most participants reported that lack of information about the new setting of care, and difficulties with access and availability of care in the new setting, added to feelings of uncertainty. (2) Biographical disruption. The transition to the new setting often resulted in changes to sense of independence and identity, and maintaining normality was a way to cope with this. (3) Importance of continuity of care. Continuity of care had an impact on feelings of safety in the new setting and influenced decisions about the transition. (4) Need for emotional and practical support. Most participants expressed a greater need for emotional and practical support, when transitioning to a new setting. CONCLUSIONS Findings provide insights into how clinicians might better negotiate transitions for these patients and family caregivers, as well as improve patient outcomes. The complexity and diversity of transition experiences, particularly among patients and families from different ethnicities and cultural backgrounds, need to be further explored in future research.
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Affiliation(s)
- Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Cathryn Pinto
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Beth Edwards
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Sophie Pask
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Alice Firth
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Suzanne O'Brien
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Fliss Em Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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14
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Can we determine burdensome transitions in the last year of life based on time of occurrence and frequency? An explanatory mixed-methods study. Palliat Support Care 2021; 20:637-645. [DOI: 10.1017/s1478951521001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Objective
Burdensome transitions are typically defined as having a transition in the last three days or multiple hospitalizations in the last three months of life, which is seldom verified with qualitative accounts from persons concerned. This study analyses types and frequencies of transitions in the last year of life and indicators of burdensome transitions from the perspective of bereaved relatives.
Method
Cross-sectional explanatory mixed-methods study with 351 surveyed and 41 interviewed bereaved relatives in a German urban area. Frequencies, t-tests, and Spearman correlations were computed for quantitative data. Qualitative data were analyzed using content analysis with provisional and descriptive coding/subcoding.
Results
Transitions rise sharply during the last year of life. 8.2% of patients experience a transition in the last three days and 7.8% three or more hospitalizations in the last three months of life. An empathetic way of telling patients about the prospect of death is associated with fewer transitions in the last month of life (r = 0.185, p = 0.046). Professionals being aware of the preferred place of death corresponds to fewer hospitalizations in the last three months of life (1.28 vs. 0.97, p = 0.021). Qualitative data do not confirm that burden in transitions is linked to having transitions in the last three days or multiple hospitalizations in the last three months of life. Burden is associated with (1) late and non-empathetic communication about the prospect of death, (2) not coordinating care across settings, and (3) not considering patients’ preferences.
Significance of results
Time of occurrence and frequency appear to be imperfect proxies for burdensome transitions. The subjective burden seems to be associated rather with insufficient information, preparation, and management of transitions.
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15
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Duke S, Richardson A, May C, Lund S, Lunt N, Campling N. Evaluation of the usability, accessibility and acceptability for a family support intervention (Family-Focused Support Conversation) for end of life care discharge planning from hospital: A participatory learning and action research study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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16
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Engel M, van der Padt-Pruijsten A, Huijben AMT, Kuijper TM, Leys MBL, Talsma A, van der Heide A. Quality of hospital discharge letters for patients at the end of life: A retrospective medical record review. Eur J Cancer Care (Engl) 2021; 31:e13524. [PMID: 34697850 PMCID: PMC9285046 DOI: 10.1111/ecc.13524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/29/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
Objective For patients who are discharged to go home after a hospitalisation, timely and adequately informing their general practitioner is important for continuity of care, especially at the end of life. We studied the quality of the hospital discharge letter for patients who were hospitalised in their last year of life. Methods A retrospective medical record review was performed. Included patients had been admitted to the hospital during the period 1 January to 1 July 2017 and had died within a year after discharge. Results Data were collected from records of 108 patients with cancer or other diseases. For 57 patients (53%), the discharge letter included information that related to their limited life expectancy (e.g., agreements about treatment limitations), whereas the patient's limited life expectancy was addressed in the medical record in 76 cases (70%). We found related information in discharge letters for 36 patients (66%) who died <3 months compared to 21 patients (40%) who died 3–12 months after hospitalisation (p < 0.01). Conclusion For patients with a limited life expectancy going home after a hospitalisation, one out of two hospital discharge letters lacked any information addressing their limited life expectancy. Specific guidelines for medical information exchange between care settings are needed.
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Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Auke M T Huijben
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Maria B L Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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Engel M, van der Ark A, Tamerus R, van der Heide A. Quality of collaboration and information handovers in palliative care: a survey study on the perspectives of nurses in the Southwest Region of the Netherlands. Eur J Public Health 2021; 30:720-727. [PMID: 32221585 PMCID: PMC7445043 DOI: 10.1093/eurpub/ckaa046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background When patients receiving palliative care are transferred between care settings, adequate collaboration and information exchange between health care professionals is necessary to ensure continuity, efficiency and safety of care. Several studies identified deficits in communication and information exchange between care settings. Aim of this study was to get insight in the quality of collaboration and information exchange in palliative care from the perspectives of nurses. Methods We performed a cross-sectional regional survey study among nurses working in different care settings. Nurses were approached via professional networks and media. Respondents were asked questions about collaboration in palliative care in general and about their last deceased patient. Potential associations between quality scores for collaboration and information handovers and characteristics of respondents or patients were tested with Pearson’s chi-square test. Results A total of 933 nurses filled in the questionnaire. Nurses working in nursing homes were least positive about inter-organizational collaboration. Forty-six per cent of all nurses had actively searched for such collaboration in the last year. For their last deceased patient, 10% of all nurses had not received the information handover in time, 33% missed information they needed. An adequate information handover was positively associated with timeliness and completeness of the information and the patient being well-informed, not with procedural characteristics. Conclusion Nurses report that collaboration between care settings and information exchange in palliative care is suboptimal. This study suggests that health care organizations should give more attention to shared professionalization towards inter-organizational collaboration among nurses in order to facilitate high-quality palliative care.
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Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrée van der Ark
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rosanne Tamerus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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18
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Engel M, Stoppelenburg A, van der Ark A, Bols FM, Bruggeman J, Janssens-van Vliet ECJ, Kleingeld-van der Windt JH, Pladdet IE, To-Baert AEMJ, van Zuylen L, van der Heide A. Development and implementation of a transmural palliative care consultation service: a multiple case study in the Netherlands. BMC Palliat Care 2021; 20:81. [PMID: 34090394 PMCID: PMC8180007 DOI: 10.1186/s12904-021-00767-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background In the Netherlands, healthcare professionals attending patients in the last phase of life, can consult an expert palliative care team (PCT) in case of complex problems. There are two types of PCTs: regional PCTs, which are mainly consulted by general practitioners, and hospital PCTs, which are mainly consulted by healthcare professionals in the hospital. Integration of these PCTs is expected to facilitate continuity of care for patients receiving care in different settings. We studied facilitators and barriers in the process of developing and implementing an integrated transmural palliative care consultation service. Methods A multiple case study was performed in four palliative care networks in the southwest Netherlands. We aimed to develop an integrated transmural palliative care consultation service. Researchers were closely observing the process and participated in project team meetings. A within-case analysis was conducted for each network, using the Consolidated Framework for Implementation Research (CFIR). Subsequently, all findings were pooled. Results In each network, project team members thought that the core goal of a transmural consultation service is improvement of continuity of palliative care for patients throughout their illness trajectory. It was nevertheless a challenge for hospital and non-hospital healthcare professionals to arrive at a shared view on goals, activities and working procedures of the transmural consultation service. All project teams experienced the lack of evidence-based guidance on how to organise the service as a barrier. The role of the management of the involved care organisations was sometimes perceived as unsupportive, and different financial reimbursement systems for hospital and out-of-hospital care made implementation of a transmural consultation service complex. Three networks managed to develop and implement a transmural service at some level, one network did not manage to do so. Conclusions Healthcare professionals are motivated to collaborate in a transmural palliative care consultation service, because they believe it can contribute to high-quality palliative care. However, they need more shared views on goals and activities of a transmural consultation service, more guidance on organisational issues and appropriate financing. Further research is needed to provide evidence on benefits and costs of different models of integrated transmural palliative care consultation services.
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Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Arianne Stoppelenburg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrée van der Ark
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Floor M Bols
- Department of Palliative Care, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | | | | | | | | | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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19
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Hanna N, Quach B, Scott M, Qureshi D, Tanuseputro P, Webber C. Operationalizing Burdensome Transitions Among Adults at the End of Life: A Scoping Review. J Pain Symptom Manage 2021; 61:1261-1277.e10. [PMID: 33096215 DOI: 10.1016/j.jpainsymman.2020.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022]
Abstract
CONTEXT Care transitions at the end of life are associated with reduced quality of life and negative health outcomes, yet up to half of patients in developed countries experience a transition within the last month of life. A variety of these transitions have been described as "burdensome" in the literature; however, there is currently no consensus on the definition of a burdensome transition. OBJECTIVES The purpose of this review was to identify current definitions of "burdensome transitions" and develop a framework for classifying transitions as "burdensome" at the end of life. METHODS A search was conducted in databases including Embase, PubMed, Cochrane Database of Systematic Reviews, Cochrane Controlled Register of Trials, CINAHL, and PsychINFO for articles published in English between January 1, 2000 and September 28, 2019. RESULTS A total of 37 articles met inclusion criteria for this scoping review. Definitions of burdensome transitions were characterized by the following features: transition setting trajectory, number of transitions, temporal relationship to end of life, or quality of transitions. CONCLUSION Definitions of burdensome transitions varied based on time before death, setting of cohorts, and study population. These definitions can be helpful in identifying and subsequently preventing unnecessary transitions at the end of life.
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Affiliation(s)
- Nardin Hanna
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada.
| | - Bradley Quach
- Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mary Scott
- Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danial Qureshi
- Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa
| | - Colleen Webber
- Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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20
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Onwuteaka-Philipsen BD, Pasman HRW, Korfage IJ, Witkamp E, Zee M, van Lent LG, Goossensen A, van der Heide A. Dying in times of the coronavirus: An online survey among healthcare professionals about end-of-life care for patients dying with and without COVID-19 (the CO-LIVE study). Palliat Med 2021; 35:830-842. [PMID: 33825567 PMCID: PMC8114455 DOI: 10.1177/02692163211003778] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND During the COVID-19 outbreak restricting measures may have affected the provision of good end-of-life care for patients with and without COVID-19. AIM To describe characteristics of patients who died and the care they received, and to examine how patient characteristics, setting and visiting restrictions are related to provided care and evaluation of the dying process. DESIGN An open observational online survey among healthcare professionals about their experience of end-of-life care that was provided to a patient with or without COVID-19 who died between March and July 2020. SETTING/PARTICIPANTS Healthcare professionals (nurses, physicians and others) in the Netherlands from all settings: home (n = 163), hospital (n = 249), nursing home (n = 192), hospice (n = 89) or elsewhere (n = 68). RESULTS Of patients reported on, 56% had COVID-19. Among these patients, 358 (84.4%) also had a serious chronic illness. Having COVID-19 was negatively, and having a serious chronic illness was positively associated with healthcare staff's favourable appreciation of end-of-life care. Often there had been visiting restrictions in the last 2 days of life (75.8%). This was negatively associated with appreciation of care at the end of life and the dying process. Finally, care at the end of life was less favourably appreciated in hospitals and especially nursing homes, and more favourably in home settings and especially hospices. CONCLUSIONS Our study suggests that end-of-life care during the COVID-19 pandemic may be further optimised, especially in nursing homes and hospitals. Allowing at least some level of visits of relatives seems a key component.
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Affiliation(s)
- Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Erica Witkamp
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Masha Zee
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Liza Gg van Lent
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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21
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Szilcz M, Wastesson JW, Johnell K, Morin L. Unplanned hospitalisations in older people: illness trajectories in the last year of life. BMJ Support Palliat Care 2021:bmjspcare-2020-002778. [PMID: 33906860 DOI: 10.1136/bmjspcare-2020-002778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/14/2021] [Accepted: 03/24/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Unplanned hospitalisations can be burdensome for older people who approach the end of life. Hospitalisations disrupt the continuity of care and often run against patients' preference for comfort and palliative goals of care. This study aimed to describe the patterns of unplanned hospitalisations across illness trajectories in the last year of life. METHODS Longitudinal, retrospective cohort study of decedents, including all older adults (≥65 years) who died in Sweden in 2015. We used nationwide data from the National Cause of Death Register linked at the individual level with several other administrative and healthcare registers. Illness trajectories were defined based on multiple-cause-of-death data to approximate functional decline near the end of life. Incidence rate ratios (IRR) for unplanned hospitalisations were modelled with zero-inflated Poisson regressions. RESULTS In a total of 77 315 older decedents (53% women, median age 85.2 years), the overall incidence rate of unplanned hospitalisations during the last year of life was 175 per 100 patient-years. The adjusted IRR for unplanned hospitalisation was 1.20 (95%CI 1.18 to 1.21) times higher than average among decedents who followed a trajectory of cancer. Conversely, decedents who followed the trajectory of prolonged dwindling had a lower-than-average risk of unplanned hospitalisation (IRR 0.66, 95% CI 0.65 to 0.68). However, these differences between illness trajectories only became evident during the last 3 months of life. CONCLUSION Our study highlights that, during the last 3 months of life, unplanned hospitalisations are increasingly frequent. Policies aiming to reduce burdensome care transitions should consider the underlying illness trajectories.
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Affiliation(s)
- Máté Szilcz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas W Wastesson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lucas Morin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Inserm CIC 1431, University Hospital of Besançon, Besançon, France
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22
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Engel M, van Zuylen L, van der Ark A, van der Heide A. Palliative care nurse champions' views on their role and impact: a qualitative interview study among hospital and home care nurses. BMC Palliat Care 2021; 20:34. [PMID: 33602177 PMCID: PMC7893717 DOI: 10.1186/s12904-021-00726-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background One of the strategies to promote the quality of palliative care in non-specialised settings is the appointment of palliative care nurse champions. It is unclear what the most effective model to implement the concept of nurse champions is and little is known about palliative care nurse champions’ own views on their role and responsibilities. This paper aims to describe views of palliative care nurse champions in hospitals and home care on their role, responsibilities and added value. Methods In 2018, a qualitative interview study was conducted with 16 palliative care nurse champions in two hospitals and four home care organisations in the southwest of the Netherlands. The framework approach was used to analyse the data. Results Most palliative care nurse champions described their role by explaining concrete tasks or activities. Most nurse champions perceive their main task as disseminating information about palliative care to colleagues. A few nurses mentioned activities aimed at raising awareness of palliative care among colleagues. Most nurses were to a limited extent involved in collaboration with the palliative care expert team. Hospital nurse champions suggested that more support from the palliative care expert team would be helpful. Most nurse champions feel little responsibility for organisational tasks and inter-organisational collaboration. Especially hospital nurses found it difficult to describe their role. Conclusion The role of palliative care nurse champions in hospital and home care varies a lot and nurses have diverging views on palliative care in these settings. Comprehensively fulfilling the role of palliative care nurse champion is a challenge. Careful selection, training, support and task descriptions for nurse champions are needed to make the concept of nurse champions work in palliative care. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00726-1.
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Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Andrée van der Ark
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Kasdorf A, Dust G, Vennedey V, Rietz C, Polidori MC, Voltz R, Strupp J. What are the risk factors for avoidable transitions in the last year of life? A qualitative exploration of professionals' perspectives for improving care in Germany. BMC Health Serv Res 2021; 21:147. [PMID: 33588851 PMCID: PMC7885553 DOI: 10.1186/s12913-021-06138-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/31/2021] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about the nature of patients’ transitions between healthcare settings in the last year of life (LYOL) in Germany. Patients often experience transitions between different healthcare settings, such as hospitals and long-term facilities including nursing homes and hospices. The perspective of healthcare professionals can therefore provide information on transitions in the LYOL that are avoidable from a medical perspective. This study aims to explore factors influencing avoidable transitions across healthcare settings in the LYOL and to disclose how these could be prevented. Methods Two focus groups (n = 11) and five individual interviews were conducted with healthcare professionals working in hospitals, hospices and nursing services from Cologne, Germany. They were asked to share their observations about avoidable transitions in the LYOL. The data collection continued until the point of information power was reached and were audio recorded and analysed using qualitative content analysis. Results Four factors for potentially avoidable transitions between care settings in the LYOL were identified: healthcare system, organization, healthcare professional, patient and relatives. According to the participants, the most relevant aspects that can aid in reducing unnecessary transitions include timely identification and communication of the LYOL; consideration of palliative care options; availability and accessibility of care services; and having a healthcare professional taking main responsibility for care planning. Conclusions Preventing avoidable transitions by considering the multicomponent factors related to them not only immediately before death but also in the LYOL could help to provide more value-based care for patients and improving their quality of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06138-4.
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Affiliation(s)
- Alina Kasdorf
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.
| | - Gloria Dust
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Christian Rietz
- Department of Educational Science and Mixed-Methods-Research, University of Education Heidelberg, Faculty of Educational and Social Sciences, Heidelberg, Germany
| | - Maria C Polidori
- Department II of Internal Medicine and Cologne Center for Molecular Medicine, Ageing Clinical Research, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,Cluster of Excellence CECAD, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,Clinical Trials Center (ZKS), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,Center for Health Services Research, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
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Mertens F, Debrulle Z, Lindskog E, Deliens L, Deveugele M, Pype P. Healthcare professionals' experiences of inter-professional collaboration during patient's transfers between care settings in palliative care: A focus group study. Palliat Med 2021; 35:355-366. [PMID: 33126837 DOI: 10.1177/0269216320968741] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Continuity of care is challenging when transferring patients across palliative care settings. These transfers are common due to the complexity of palliative care, which has increased significantly since the advent of palliative care services. It is unclear how palliative care services and professionals currently collaborate and communicate to ensure the continuity of care across settings, and how patient and family members are involved. AIM To explore healthcare professionals' experiences regarding the communicative aspects of inter-professional collaboration and the involvement of patient and family members. DESIGN Qualitative design, including focus group discussions. SETTING/PARTICIPANTS The study focused on one palliative care network in Belgium and involved all palliative care settings: hospital, hospital's palliative care unit, home care, nursing home. Nine group discussions were conducted, with diverse professionals (n = 53) from different care settings. RESULTS Timely and effective inter-professional information exchange was considered fundamental. A perceived barrier for interprofessional collaboration was the lack of a shared electronic health record. Efficiency regarding multidisciplinary team meetings and inter-professional communication were subject to improvement.A striking study finding was the perceived insufficient open communication of specialists towards patients and the lack of shared decision making. This not only hampered advance care planning discussions and early integration of palliative home care, but also the functioning of other professionals. CONCLUSION From the perspective of the integrated care framework, several areas of improvement on different levels of care and collaboration are identified. Support from policymakers and researchers is required to achieve integrated palliative care in regional networks.
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Affiliation(s)
- Fien Mertens
- General Practitioner, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,VUB, Belgium.,End-of-Life Care Research Group
| | | | | | - Luc Deliens
- End-of-Life Care Research Group.,Professor of Palliative Care Research, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Family Medicine and Chronic Care, VUB, Belgium
| | - Myriam Deveugele
- Professor em. Communication in Health Care, Psychologist, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Peter Pype
- End-of-Life Care Research Group.,Professor Interprofessional Collaboration in Education and Practice, General Practitioner, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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The Association between Home Healthcare and Burdensome Transitions at the End-of-Life in People with Dementia: A 12-Year Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249255. [PMID: 33322024 PMCID: PMC7764349 DOI: 10.3390/ijerph17249255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND For people with dementia, burdensome transitions may indicate poorer-quality end-of-life care. Little is known regarding the association between home healthcare (HHC) and these burdensome transitions. We aimed to investigate the impact of HHC on transitions and hospital/intensive care unit (ICU) utilisation nearing the end-of-life for people with dementia at a national level. METHODS A nested case-control analysis was applied in a retrospective cohort study using a nationwide electronic records database. We included people with new dementia diagnoses who died during 2002-2013 in whole population data from the universal healthcare system in Taiwan. Burdensome transitions were defined as multiple hospitalisations in the last 90 days (early transitions, ET) or any hospitalisation or emergency room visit in the last three days of life (late transitions, LT). People with (cases) and without (controls) burdensome transitions were matched on a ratio of 1:2. We performed conditional logistic regression with stratified analyses to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) of the risks of transitions. RESULTS Among 150,125 people with new dementia diagnoses, 61,399 died during follow-up, and 31.1% had burdensome transitions (50% were early and 50% late). People with ET had the highest frequency of admissions and longer stays in hospital/ICU during their last year of life, while people with LT had fewer hospital/ICU utilisation than people without end-of-life transitions. Receiving HHC was associated with an increased risk of ET (OR = 1.14, 95 % CI: 1.08-1.21) but a decreased risk of LT (OR = 0.89, 95 % CI 0.83-0.94). In the people receiving HHC, however, those who received longer duration (e.g., OR = 0.50, 95 % CI: 0.42-0.60, >365 versus ≤30 days) or more frequent HHC or HHC delivered closer to the time of death were associated with a remarkably lower risk of ET. CONCLUSIONS HHC has differential effects on early and late transitions. Characteristics of HHC such as better continuity or interdisciplinary coordination may reduce the risk of transitions at the end-of-life. We need further studies to understand the longitudinal effects of HHC and its synergy with palliative care, as well as the key components of HHC that achieve better end-of-life outcomes.
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Physicians' perspectives on estimating and communicating prognosis in palliative care: a cross-sectional survey. BJGP Open 2020; 4:bjgpopen20X101078. [PMID: 32967841 PMCID: PMC7606137 DOI: 10.3399/bjgpopen20x101078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background Advance care planning (ACP) can help to enhance the care of patients with limited life expectancy. Despite physicians’ key role in ACP, the ways in which physicians estimate and communicate prognosis can be improved. Aim To determine how physicians in different care settings self-assess their performance in estimating and communicating prognosis to patients in palliative care, and how they perceive their communication with other physicians about patients’ poor prognosis. Design & setting A survey study was performed among a random sample of GPs, hospital physicians (HPs), and nursing home physicians (NHPs) in the southwest of the Netherlands (n = 2212). Method A questionnaire was developed that had three versions for GPs, HPs, and NHPs. Each specialism filled in an appropriate version. Results A total of 547 physicians participated: 259 GPs, 205 HPs, and 83 NHPs. In the study, 61.1% of physicians indicated being able to adequately estimate whether a patient will die within 1 year, which was associated with use of the Surprise Question (odds ratio [OR] = 1.65, P = 0.042). In the case of a prognosis of <1 year, 75.0% of physicians indicated that they communicate with patients about preferences regarding treatment and care, which was associated with physicians being trained in palliative care (OR = 2.02, P=0.007). In cases where patients with poor prognosis are discharged after hospital admission, 83.4% of HPs indicated that they inform GPs about these patients’ preferences compared with 29.0% of GPs, and 21.7% of NHPs, who indicated that they are usually adequately informed about the preferences. Conclusion The majority of physicians indicated that they believe they can adequately estimate patients’ limited life expectancy and that they discuss patients’ preferences for care. However, more physicians should be trained in communicating about patients’ poor prognosis and care preferences.
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Duke S, Campling N, May CR, Lund S, Lunt N, Richardson A. Co-construction of the family-focused support conversation: a participatory learning and action research study to implement support for family members whose relatives are being discharged for end-of-life care at home or in a nursing home. BMC Palliat Care 2020; 19:146. [PMID: 32957952 PMCID: PMC7507823 DOI: 10.1186/s12904-020-00647-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many people move in and out of hospital in the last few weeks of life. These care transitions can be distressing for family members because they signify the deterioration and impending death of their ill relative and forthcoming family bereavement. Whilst there is evidence about psychosocial support for family members providing end-of-life care at home, there is limited evidence about how this can be provided in acute hospitals during care transitions. Consequently, family members report a lack of support from hospital-based healthcare professionals. METHODS The aim of the study was to implement research evidence for family support at the end-of-life in acute hospital care. Informed by Participatory Learning and Action Research and Normalization Process Theory (NPT) we co-designed a context-specific intervention, the Family-Focused Support Conversation, from a detailed review of research evidence. We undertook a pilot implementation in three acute hospital Trusts in England to assess the potential for the intervention to be used in clinical practice. Pilot implementation was undertaken during a three-month period by seven clinical co-researchers - nurses and occupational therapists in hospital specialist palliative care services. Implementation was evaluated through data comprised of reflective records of intervention delivery (n = 22), in-depth records of telephone implementation support meetings between research team members and co-researchers (n = 3), and in-depth evaluation meetings (n = 2). Data were qualitatively analysed using an NPT framework designed for intervention evaluation. RESULTS Clinical co-researchers readily incorporated the Family-Focused Support Conversation into their everyday work. The intervention changed family support from being solely patient-focused, providing information about patient needs, to family-focused, identifying family concerns about the significance and implications of discharge and facilitating family-focused care. Co-researchers reported an increase in family members' involvement in discharge decisions and end-of-life care planning. CONCLUSION The Family-Focused Support Conversation is a novel, evidenced-based and context specific intervention. Pilot implementation demonstrated the potential for the intervention to be used in acute hospitals to support family members during end-of-life care transitions. This subsequently informed a larger scale implementation study. TRIAL REGISTRATION n/a.
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Affiliation(s)
- Sue Duke
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, England.
| | - Natasha Campling
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, England
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England
| | - Susi Lund
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, England
| | - Neil Lunt
- Department of Social Policy and Social Work, University of York, Heslington, York, YO10 5DD, England
| | - Alison Richardson
- University Hospitals Southampton and School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, England
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Flierman I, van Rijn M, de Meij M, Poels M, Niezink DM, Willems DL, Buurman BM. Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life. Pilot Feasibility Stud 2020; 6:129. [PMID: 32944277 PMCID: PMC7490875 DOI: 10.1186/s40814-020-00676-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A transitional care pathway (TCP) could improve care for older patients in the last months of life. However, barriers exist such as unidentified palliative care needs and suboptimal collaboration between care settings. The aim of this study was to determine the feasibility of a TCP, named PalliSupport, for older patients at the end of life, prior to a stepped-wedge randomized controlled trial. METHODS A mixed-method feasibility study was conducted at one hospital with affiliated primary care. Patients were ≥ 60 years and acutely hospitalized. The intervention consisted of (1) training on early identification of the palliative phase and end of life conversations, (2) involvement of a transitional palliative care team during admission and post-discharge and (3) intensified collaboration between care settings. Outcomes were feasibility of recruitment, data collection, patient burden and protocol adherence. Experiences of 14 professionals were assessed through qualitative interviews. RESULTS Only 16% of anticipated participants were included which resulted in difficulty assessing other feasibility criteria. The qualitative analysis identified misunderstandings about palliative care, uncertainty about professionals' roles and difficulties in initiating end of life conversations as barriers. The training program was well received and professionals found the intensified collaboration beneficial for patient care. The patients that participated experienced low burden and data collection on primary outcomes and protocol adherence seems feasible. DISCUSSION This study highlights the importance of performing a feasibility study prior to embarking on effectiveness studies. Moving forward, the PalliSupport care pathway will be adjusted to incorporate a more active recruitment approach, additional training on identification and palliative care, and further improvement on data collection.
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Affiliation(s)
- Isabelle Flierman
- Amsterdam UMC, Department of General Practice, Section of Medical Ethics, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marjon van Rijn
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
| | - Marike de Meij
- OLVG, Palliative and Supportive Care Team, Oncology Centre Amsterdam, Oosterpark 9, Amsterdam, The Netherlands
| | - Marjolein Poels
- Care2research, Mattenbiesstraat 133, Amsterdam, the Netherlands
| | - Dorende M. Niezink
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Dick L. Willems
- Amsterdam UMC, Department of General Practice, Section of Medical Ethics, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Bianca M. Buurman
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
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Tuppin P, Tanguy-Melac A, Lesuffleur T, Janah A, Gastaldi-Ménager C, Fagot-Campagna A. Intensity of care for cancer patients treated mainly at home during the month before their death: An observational study. Presse Med 2019; 48:e293-e306. [PMID: 31734050 DOI: 10.1016/j.lpm.2019.09.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/12/2019] [Accepted: 09/25/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Little is known regarding healthcare for cancer patients treated mainly at home during the month before they die. The aim of this study was to provide information on how they were treated and what were their causes of death. METHODS This population-based observational study analysing information obtained from the French national healthcare data system (SNDS) included adult health insurance beneficiaries treated for cancer who died in 2015 after having spent at least 25 of their last 30 days at home. RESULTS Among the cancer patients who died in 2015, 25,463 (20%) were included [mean age (±SD) 74±13.2 years, men 62%]; 54% of them died at home. They were slightly older (75 vs. 73 years) than those who died in hospital, had less frequently received hospital palliative care during the year preceding their deaths (19% vs. 41%) and had less often used medical transport (41% vs. 73%) to an emergency department (8% vs. 62%), to hospital-based (11% vs. 17%) or community-based (16% vs. 12%) chemotherapy, to a general practitioner (73% vs. 78%) or to a community-based nursing service (63% vs. 73%). However, when they consulted a general practitioner (median 3 visits vs. 2) or a nurse (median 22 nursing procedures vs. 10) during their last month of life, visits were more frequent. The leading cause of death was tumour, which represented 69% of deaths at home vs. 74% of deaths in hospital. CONCLUSIONS In France, home management during the last month of life is uncommon and even when it is occurs, in one out of two cases patients pass away in a hospital setting. This study is an interrogation on medical choices, given the wish of many of the French to die at home and placing their choices in an international perspective.
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Affiliation(s)
| | | | | | - Asmaa Janah
- Aix Marseille University, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Inserm, Marseille, France
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Hermans S, Sevenants A, Declercq A, Broeck NV, Deliens L, Cohen J, Audenhove CV. Inter-organisational collaboration in palliative care trajectories for nursing home residents: A nation-wide mixed methods study among key persons. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519857352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Multiple care organisations, such as home care services, nursing homes and hospitals, are responsible for providing an appropriate response to the palliative care needs of older people admitted into long-term care facilities. Integrated palliative care aims to provide seamless and continuous care. A possible organisational strategy to help realise integrated palliative care for this population is to create a network in which these organisations collaborate. The aim is to analyse the collaboration processes of the various organisations involved in providing palliative care to nursing home residents. Method A sequential mixed-methods study, including a survey sent to 502 participants to evaluate the collaboration between home and residential care, and between hospital and residential care, and additionally three focus group interviews involving a purposive selection among the survey participants. Participants are key persons from the nursing homes, hospitals and home care organisations that are part of the 15 Flemish palliative care networks dispersed throughout the region of Flanders, Belgium. Results Survey data were gathered from 308 key persons (response rate: 61%), and 16 people participated in three focus group interviews. Interpersonal dimensions of collaboration are rated higher than structural dimensions. This effect is statistically significant. Qualitative analyses identified guidelines, education, and information-transfer as structural challenges. Additionally, for further development, members should become acquainted and the network should prioritise the establishment of a communication infrastructure, shared leadership support and formalisation. Discussion The insights of key persons suggest the need for further structuration and can serve as a guideline for interventions directed at improving inter-organisational collaboration in palliative care trajectories for nursing home residents.
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Affiliation(s)
| | | | | | | | - Luc Deliens
- Vrije Universiteit Brussel (VUB), Belgium
- Ghent University, Belgium
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31
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Hermans S, Sevenants A, Declercq A, Van Broeck N, Deliens L, Cohen J, Van Audenhove C. Integrated Palliative Care for Nursing Home Residents: Exploring the Challenges in the Collaboration between Nursing Homes, Home Care and Hospitals. Int J Integr Care 2019; 19:3. [PMID: 30971869 PMCID: PMC6450250 DOI: 10.5334/ijic.4186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 03/12/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Nursing home residents are a vulnerable and frail segment of the population, characterised by their complex and palliative care needs. To ensure an integrated approach to palliative care for this target group, working on a collaborative basis with multiple providers across organisational boundaries is necessary. Considering that coordinators of palliative networks support and coordinate collaboration, the research question is: 'how do network coordinators perceive the process of collaboration between organisations in Flemish palliative networks?' METHODS A dual-phase sequential mixed-methods design was applied. First, the coordinators of each of the fifteen palliative networks in Flanders completed a survey in which they evaluated ten aspects of collaboration for two types of cooperation: between nursing homes and home care, and between nursing homes and hospitals. Next, the survey results thus obtained were discussed to improve understanding in a focus group composed of the above coordinators, and which was analysed on the basis of content analysis. RESULTS In both forms of cooperation, the 'formalisation' and 'governance' were the aspects that yielded the lowest mean scores. The coordinators in the focus group expressed a need for more formalised interaction among organisations with regard to palliative care, the establishment of formal channels of communication and the exchange of information, as well as the development of shared leadership. CONCLUSIONS The perspectives of the coordinators on inter-organisational collaboration are a valuable starting point for interventions directed at the stronger integration of palliative care for residents of long term-care facilities.
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Affiliation(s)
- Sofie Hermans
- KU Leuven – University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat, Leuven, BE
| | - Aline Sevenants
- KU Leuven – University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat, Leuven, BE
| | - Anja Declercq
- KU Leuven – University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat, Leuven, BE
| | - Nady Van Broeck
- KU Leuven – University of Leuven, Department of Clinical Psychology, Tiensestraat, Leuven, BE
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, BE
- Department of Internal Medicine, Ghent University, Ghent, BE
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, BE
| | - Chantal Van Audenhove
- KU Leuven – University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat, Leuven, BE
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Wind J, Nugteren IC, van Laarhoven HWM, van Weert HCPM, Henselmans I. Who should provide care for patients receiving palliative chemotherapy? A qualitative study among Dutch general practitioners and oncologists. Scand J Prim Health Care 2018; 36:437-445. [PMID: 30375906 PMCID: PMC6381534 DOI: 10.1080/02813432.2018.1535264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION While close collaboration between general practitioners (GPs) and hospital specialists is considered important, the sharing of care responsibilities between GPs and oncologists during palliative chemotherapy has not been clearly defined. OBJECTIVE Evaluate the opinions of GPs and oncologists about who should provide different aspects of care for patients receiving palliative chemotherapy. DESIGN We conducted semi-structured interviews using six hypothetical scenarios with purposively sampled GPs (n = 12) and oncologists (n = 10) in the Netherlands. Each represented an example of a clinical problem requiring different aspects of care: problems likely, or not, related to cancer or chemotherapy, need for decision support, and end-of-life care. RESULTS GPs and oncologists agreed that GPs should provide end-of-life care and that they should be involved in decisions about palliative chemotherapy; however, for the other scenarios most participants considered themselves the most appropriate provider of care. Themes that emerged regarding who would provide the best care for the patients in the different scenarios were expertise, continuity of care, accessibility of care, doctor-patient relationship, and communication. Most participants mentioned improved communication between the GP and oncologist as being essential for a better coordination and quality of care. CONCLUSION GPs and oncologists have different opinions about who should ideally provide different aspects of care during palliative chemotherapy. Findings raise awareness of the differences in reasoning and approaches and in current communication deficits between the two groups of health professionals. These findings could be used to improve coordination and collaboration and, ultimately, better patient care as results demonstrated that both disciplines can add value to the care for patients with advanced cancer. Key points This study identified contrasting opinions of GPs and oncologists about who should provide different aspects of care for patients receiving palliative chemotherapy. Important themes that emerged were expertise, continuity of care, doctor-patient relations, accessibility of care, and communication. Although frequently using the same arguments, GPs and oncologists often considered themselves to be the most appropriate providers of palliative care.
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Affiliation(s)
- Jan Wind
- Department of General Practice, Academic Medical Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands;
- CONTACT Jan Wind Department of General Practice, Academic Medical Centre Amsterdam, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Ineke C. Nugteren
- Department of General Practice, Academic Medical Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands;
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Academic Medical Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands;
| | - Henk C. P. M. van Weert
- Department of General Practice, Academic Medical Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands;
| | - Inge Henselmans
- Department of Medical Psychology, Academic Medical Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
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Ding J, Johnson CE, Cook A. How We Should Assess the Delivery of End-Of-Life Care in General Practice? A Systematic Review. J Palliat Med 2018; 21:1790-1805. [PMID: 30129811 DOI: 10.1089/jpm.2018.0194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The majority of end-of-life (EOL) care occurs in general practice. However, we still have little knowledge about how this care is delivered or how it can be assessed and supported. AIM (i) To review the existing evaluation tools used for assessment of the delivery of EOL care from the perspective of general practice; (ii) To describe how EOL care is provided in general practice; (iii) To identify major areas of concern in providing EOL care in this context. DESIGN A systematic review. DATA SOURCES Systematic searches of major electronic databases (Medline, EMBASE, PsycINFO, and CINAHL) from inception to 2017 were used to identify evaluation tools focusing on organizational structures/systems and process of end-of-life care from a general practice perspective. RESULTS A total of 43 studies representing nine evaluation tools were included. A relatively restricted focus and lack of validation were common limitations. Key general practitioner (GP) activities assessed by the evaluation tools were summarized and the main issues in current GP EOL care practice were identified. CONCLUSIONS The review of evaluation tools revealed that GPs are highly involved in management of patients at the EOL, but there are a range of issues relating to the delivery of care. An EOL care registration system integrated with electronic health records could provide an optimal approach to address the concerns about recall bias and time demands in retrospective analyses. Such a system should ideally capture the core GP activities and any major issues in care provision on a case-by-case basis.
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Affiliation(s)
- Jinfeng Ding
- 1 School of Population and Global Health, University of Western Australia , Perth, Western Australia, Australia
| | - Claire E Johnson
- 2 Cancer and Palliative Care Research and Evaluation Unit (CaPCREU), Medical School, University of Western Australia , Perth, Western Australia, Australia
- 3 School of Nursing and Midwifery, Monash University , Melbourne, Victoria, Australia
| | - Angus Cook
- 1 School of Population and Global Health, University of Western Australia , Perth, Western Australia, Australia
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Giezendanner S, Bally K, Haller DM, Jung C, Otte IC, Banderet HR, Elger BS, Zemp E, Gudat H. Reasons for and Frequency of End-of-Life Hospital Admissions: General Practitioners' Perspective on Reducing End-of-Life Hospital Referrals. J Palliat Med 2018; 21:1122-1130. [DOI: 10.1089/jpm.2017.0489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stéphanie Giezendanner
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Klaus Bally
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Dagmar M. Haller
- Department of Community Health and Medicine, Primary Care Unit, University of Geneva, Geneva, Switzerland
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Corinna Jung
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
- Department of Health Care, Careum Forschung, Kaleidos Fachhochschule, Zurich, Switzerland
| | - Ina C. Otte
- Faculty of Medicine, Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Medical Faculty, Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Hans-Ruedi Banderet
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Bernice S. Elger
- Faculty of Medicine, Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center of Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Heike Gudat
- Hospiz im Park, Hospital for Palliative Care, Arlesheim, Basel, Switzerland
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Thomas T, Clarke G, Barclay S. The difficulties of discharging hospice patients to care homes at the end of life: A focus group study. Palliat Med 2018; 32:1267-1274. [PMID: 29708014 DOI: 10.1177/0269216318772735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Discharge from inpatient palliative care units to long-term care can be challenging. In the United Kingdom, hospice inpatients move to a care home if they no longer require specialist palliative care and cannot be discharged home. There is evidence to suggest that patients and families find the prospect of such a move distressing. AIM To investigate the issues that arise when patients are transferred from hospice to care home at the end of life, from the perspective of the hospice multidisciplinary team. DESIGN A qualitative study, using thematic analysis to formulate themes from focus group discussions with hospice staff. SETTING/PARTICIPANTS Five focus groups were conducted with staff at five UK hospices. Participants included multidisciplinary team members involved in discharge decisions. All groups had representation from a senior nurse and doctor at the hospice, with group size between three and eight participants. All but one group included physiotherapists, occupational therapists and family support workers. RESULTS A major focus of group discussions concerned dilemmas around discharge. These included (1) ethical concerns (dilemmas around the decision, lack of patient autonomy and allocation of resources); (2) communication challenges; and (3) discrepancies between the ideals and realities of hospice palliative care. CONCLUSION Hospice palliative care unit staff find discharging patients to care homes necessary, but often unsatisfactory for themselves and distressing for patients and relatives. Further research is needed to understand patients' experiences concerning moving to care homes for end of life care, in order that interventions can be implemented to mitigate this distress.
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Affiliation(s)
| | - Gemma Clarke
- 2 Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- 2 Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Overbeek A, Van den Block L, Korfage IJ, Penders YWH, van der Heide A, Rietjens JAC. Admissions to inpatient care facilities in the last year of life of community-dwelling older people in Europe. Eur J Public Health 2018; 27:814-821. [PMID: 28957486 DOI: 10.1093/eurpub/ckx105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In the last year of life, many older people rather avoid admissions to inpatient care facilities. We describe and compare such admissions in the last year of life of 5092 community-dwelling older people in 15 European countries (+Israel). Methods Proxy-respondents of the older people, who participated in the longitudinal SHARE study, reported on admissions to inpatient care facilities (hospital, nursing home or hospice) during the last year of their life. Multivariable regression analyses assessed associations between hospitalizations and personal/contextual characteristics. Results The proportion of people who had been admitted at least once to an inpatient care facility in the last year of life ranged from 54% (France) to 76% (Austria, Israel, Slovenia). Admissions mostly concerned hospitalizations. Multivariable analyses showed that especially Austrians, Israelis and Poles had higher chances of being hospitalized. Further, hospitalizations were more likely for those being ill for 6 months or more (OR:1.67, CI:1.39-2.01), and less likely for persons aged 80+ (OR:0.54, CI:0.39-0.74; compared with 48-65 years), females (OR:0.74, CI:0.63-0.89) and those dying of cardiovascular diseases (OR:0.66, CI:0.51-0.86; compared with those dying of cancer). Conclusions Although healthcare policies increasingly stress the importance that people reside at home as long as possible, admissions to inpatient care facilities in the last year of life are relatively common across all countries. Furthermore, we found a striking variation concerning the proportion of admissions across countries which cannot only be explained by patient needs. It suggests that such admissions are at least partly driven by system-level or cultural factors.
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Affiliation(s)
- Anouk Overbeek
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Yolanda W H Penders
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Kjellstadli C, Husebø BS, Sandvik H, Flo E, Hunskaar S. Comparing unplanned and potentially planned home deaths: a population-based cross-sectional study. BMC Palliat Care 2018; 17:69. [PMID: 29720154 PMCID: PMC5930760 DOI: 10.1186/s12904-018-0323-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/23/2018] [Indexed: 11/17/2022] Open
Abstract
Background There is little research on number of planned home deaths. We need information about factors associated with home deaths, but also differences between planned and unplanned home deaths to improve end-of-life-care at home and make home deaths a feasible alternative. Our aim was to investigate factors associated with home deaths, estimate number of potentially planned home deaths, and differences in individual characteristics between people with and without a potentially planned home death. Methods A cross-sectional study of all decedents in Norway in 2012 and 2013, using data from the Norwegian Cause of Death Registry and National registry for statistics on municipal health and care services. We defined planned home death by an indirect algorithm-based method using domiciliary care and diagnosis. We used logistic regressions models to evaluate factors associated with home death compared with nursing home and hospital; and to compare unplanned home deaths and potentially planned home deaths. Results Among 80,908 deaths, 12,156 (15.0%) were home deaths. A home death was most frequent in ‘Circulatory diseases’ and ‘Cancer’, and associated with male sex, younger age, receiving domiciliary care and living alone. Only 2.3% of home deaths were from ‘Dementia’. In total, 41.9% of home deaths and 6.3% of all deaths were potentially planned home deaths. Potentially planned home deaths were associated with higher age, but declined in ages above 80 years for people who had municipal care. Living together with someone was associated with more potentially planned home deaths for people with municipal care. Conclusion There are few home deaths in Norway. Our estimations indicate that even fewer people than anticipated have a potentially planned home death.
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Affiliation(s)
- Camilla Kjellstadli
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, PO box 7804, N-5018, Bergen, Norway. .,Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, PO box 7804, N-5018, Bergen, Norway.
| | - Bettina Sandgathe Husebø
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, PO box 7804, N-5018, Bergen, Norway.,Bergen Municipality, Bergen, Norway
| | - Hogne Sandvik
- National Centre for Emergency Primary Health Care, Uni Research Health, Kalfarveien 31, N-5018, Bergen, Norway
| | - Elisabeth Flo
- Department of Clinical Psychology, University of Bergen, PO box 7804, N-5018, Bergen, Norway
| | - Steinar Hunskaar
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, PO box 7804, N-5018, Bergen, Norway.,National Centre for Emergency Primary Health Care, Uni Research Health, Kalfarveien 31, N-5018, Bergen, Norway
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Ryman FVM, Erisman JC, Darvey LM, Osborne J, Swartsenburg E, Syurina EV. Health Effects of the Relocation of Patients With Dementia: A Scoping Review to Inform Medical and Policy Decision-Making. THE GERONTOLOGIST 2018; 59:e674-e682. [DOI: 10.1093/geront/gny031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 11/13/2022] Open
Abstract
AbstractBackground and ObjectivesResearch into the relocation (including international relocation) of people with dementia is increasingly important due to the aging population and latest developments in the international politics (including globalization and concerns over international migration). There is need for an overview of the health effects of relocation to facilitate and inform decision- and policy-making regarding these relocations. The aim of this literature review was to provide insight into the physical, psychological, and social consequences of varied types of relocations of older adults suffering from dementia.Research Design and MethodsA scoping literature review with a systematic search was performed in PubMed, Web of Science, PsychInfo, JSTOR, and ScienceDirect. The articles dealing with subject of relocation of older adults from 1994 to 2017 were included and analyzed. Methodological quality assessment was performed for all articles.ResultsFinal list included 13 articles. The effects of relocation were discussed in terms of mortality and morbidity. In most studies, the health effects of the relocation of older adults suffering from dementia were negative. A decline in physical, mental, behavioral, and functional well-being was reported. The most recurring effect was a higher level of stress, which is more problematic for patients with dementia. In general, unless it is carefully planned, it is best to avoid changing lives of people with dementia and it is recommended to actively work to reduce their exposure to stress.Discussion and ImplicationsThe outcomes of the study suggest definite evidence for the negative effects of relocation of the older adults. This research aims to be used as the support of the legal and medical decisions of relocation of patients with dementia.
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Affiliation(s)
- Frida V M Ryman
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Jetske C Erisman
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Lea M Darvey
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Jacob Osborne
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Ella Swartsenburg
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - Elena V Syurina
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
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Kelfve S, Wastesson J, Fors S, Johnell K, Morin L. Is the level of education associated with transitions between care settings in older adults near the end of life? A nationwide, retrospective cohort study. Palliat Med 2018; 32:366-375. [PMID: 28952874 DOI: 10.1177/0269216317726249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND End-of-life transitions between care settings can be burdensome for older adults and their relatives. AIM To analyze the association between the level of education of older adults and their likelihood to experience care transitions during the final months before death. DESIGN Nationwide, retrospective cohort study using register data. SETTING/PARTICIPANTS Older adults (⩾65 years) who died in Sweden in 2013 ( n = 75,722). Place of death was the primary outcome. Institutionalization and multiple hospital admissions during the final months of life were defined as secondary outcomes. The decedents' level of education (primary, secondary, or tertiary education) was considered as the main exposure. Multivariable analyses were stratified by living arrangement and adjusted for sex, age at time of death, illness trajectory, and number of chronic diseases. RESULTS Among community-dwellers, older adults with tertiary education were more likely to die in hospitals than those with primary education (55.6% vs 49.9%; odds ratio (OR) = 1.21, 95% confidence interval (CI) = 1.14-1.28), but less likely to be institutionalized during the final month before death (OR = 0.83, 95% CI = 0.76-0.91). Decedents with higher education had greater odds of remaining hospitalized continuously during their final 2 weeks of life (OR = 1.12, 95% CI = 1.02-1.22). Among older adults living in nursing homes, we found no association between the decedents' level of education and their likelihood to be hospitalized or to die in hospitals. CONCLUSION Compared with those who completed only primary education, individuals with higher educational attainment were more likely to live at home until the end of life, but also more likely to be hospitalized and die in hospitals.
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Affiliation(s)
- Susanne Kelfve
- 1 Division Ageing and Social Change, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.,2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Jonas Wastesson
- 2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Stefan Fors
- 2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,3 Centre for Health Equity Studies, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Kristina Johnell
- 2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lucas Morin
- 2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Vanderhaeghen B, Bossuyt I, Opdebeeck S, Menten J, Rober P. Toward Hospital Implementation of Advance Care Planning: Should Hospital Professionals Be Involved? QUALITATIVE HEALTH RESEARCH 2018; 28:456-465. [PMID: 29059015 DOI: 10.1177/1049732317735834] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In Belgium, Advance Care Planning (ACP) is not well implemented in hospital practice. One of the premises for successful implementation is involving the adopters in the implementation process. In hospital, important adopters of ACP are physicians, nurses, social workers, and psychologists. First, this study wants to understand what the characteristics are of ACP in hospital, according to professionals. Second, this study aims to give an insight in the experienced value of ACP. Third, the experienced barriers to have ACP conversations are explored. Twenty-four interviews were taken and analyzed with Content Analysis based on Grounded Theory. Three independent external auditors surveilled the analysis. ACP in hospital exists by the grace of the initiative of the actors involved in the case. Professionals perceive fields of tension between one another; barriers to ACP communication. ACP is mainly considered valuable because it is a process that creates time for exploration and reflection.
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How do treatment aims in the last phase of life relate to hospitalizations and hospital mortality? A mortality follow-back study of Dutch patients with five types of cancer. Support Care Cancer 2017; 26:777-786. [PMID: 28936558 PMCID: PMC5785603 DOI: 10.1007/s00520-017-3889-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/11/2017] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study is to describe and compare the relation between treatment aims, hospitalizations, and hospital mortality for Dutch patients who died from lung, colorectal, breast, prostate, or pancreatic cancer. Methods A mortality follow-back study was conducted within a sentinel network of Dutch general practitioners (GPs), who recorded the end-of-life care of 691 patients who died from one of the abovementioned cancer types between 2009 and 2015. Differences in care by type of cancer were analyzed using multilevel analyses to control for clustering within general practices. Results Among all cancer types, patients with prostate cancer most often and patients with pancreatic cancer least often had a palliative treatment aim a month before death (95% resp. 84%). Prostate cancer patients were also least often admitted to hospital in the last month of life (18.5%) and least often died there (3.1%), whereas lung cancer patients were at the other end of the spectrum with 41.8% of them being admitted to hospital and 22.6% dying in hospital. Having a palliative treatment aim and being older were significantly associated with less hospital admissions, and having a palliative treatment aim, having prostate cancer, and dying in a more recent year were significantly associated with less hospital deaths. Conclusion There is large variation between patients with different cancer types with regard to treatment aims, hospital admissions, and hospital deaths. The results highlight the need for early initiation of GP palliative care to support patients from all cancer types to stay at the place they prefer as long as possible.
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Casotto V, Rolfini M, Ferroni E, Savioli V, Gennaro N, Avossa F, Cancian M, Figoli F, Mantoan D, Brambilla A, Ghiotto MC, Fedeli U, Saugo M. End-of-Life Place of Care, Health Care Settings, and Health Care Transitions Among Cancer Patients: Impact of an Integrated Cancer Palliative Care Plan. J Pain Symptom Manage 2017; 54:167-175. [PMID: 28479411 DOI: 10.1016/j.jpainsymman.2017.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/15/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Frequent end-of-life health care setting transitions can lead to an increased risk of fragmented care and exposure to unnecessary treatments. OBJECTIVES We assessed the relationship between the presence and the intensity of an Integrated Cancer Palliative Care (ICPC) plan and the occurrence of multiple transitions during the last month of life. METHODS Decedents of cancer aged 18-85 years residents in two regions of Italy were investigated accessing their integrated administrative data (death certificates, hospital discharges, hospice, and home care records). The principal outcome was defined as having 3+ health care setting transitions during the last month of life. The ICPC plans instituted 90-31 days before death represented the main exposure of interest. RESULTS Of the 17,604 patients, 6698 included in an ICPC, although spending in hospital a median number of only two days (interquartile range 1-2), experienced 1+ (59.8%), 2+ (21.1%), or 3+ (5.9%) health care transitions. Among the latter group, the most common trajectory of care is home-hospital-home-hospital (36.0%). The intensity of the ICPC plan showed a marked protective effect toward the event of 3+ health care setting transitions; the effect is already evident from an intensity of at least one home visit/week (odds ratio 0.73; 95% confidence interval 0.62-0.87). CONCLUSION A well-integrated palliative care approach can be effective in further reducing the percentage of patients who spent many days in hospital and/or undergo frequent and inopportune changes of their care setting during their last month of life.
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Affiliation(s)
| | - Maria Rolfini
- Direzione Sanità e Politiche Sociali, Emilia-Romagna Region, Italy
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Padova, Italy.
| | - Valentina Savioli
- Servizio Sistema Informativo Sanità e Politiche Sociali, Emilia-Romagna Region, Italy
| | - Nicola Gennaro
- Epidemiological System of the Veneto Region, Padova, Italy
| | | | | | - Franco Figoli
- Palliative Care Unit, Local Health Unit n. 4, Thiene, Italy
| | | | | | | | - Ugo Fedeli
- Epidemiological System of the Veneto Region, Padova, Italy
| | - Mario Saugo
- Epidemiological System of the Veneto Region, Padova, Italy
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van der Plas AG, Oosterveld-Vlug MG, Pasman HRW, Onwuteaka-Philipsen BD. Relating cause of death with place of care and healthcare costs in the last year of life for patients who died from cancer, chronic obstructive pulmonary disease, heart failure and dementia: A descriptive study using registry data. Palliat Med 2017; 31:338-345. [PMID: 28056634 DOI: 10.1177/0269216316685029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The four main diagnostic groups for palliative care provision are cancer, chronic obstructive pulmonary disease, heart failure and dementia. But comparisons of costs and care in the last year of life are mainly directed at cancer versus non-cancer or within cancer patients. AIM Our aim is to compare the care and expenditures in their last year of life for Dutch patients with cancer, chronic obstructive pulmonary disease, heart failure or dementia. DESIGN Data from insurance company Achmea (2009-2010) were linked to information on long-term care at home or in an institution, the National Hospital Registration and Causes of Death-Registry from Statistics Netherlands. For patients who died of cancer ( n = 8658), chronic obstructive pulmonary disease ( n = 1637), heart failure ( n = 1505) or dementia ( n = 3586), frequencies and means were calculated, Lorenz curves were drawn up and logistic regression was used to compare patients with high versus low expenditures. RESULTS For decedents with cancer and chronic obstructive pulmonary disease, the highest costs were for hospital admissions. For decedents with heart failure, the highest costs were for the care home (last 360 days) and hospital admissions (last 30 days). For decedents with dementia, the highest costs were for the nursing home. CONCLUSION Patients with dementia had the highest expenditures due to nursing home care. The number of dementia patients will double by the year 2030, resulting in even higher economic burdens than presently. Policy regarding patients with chronic conditions should be informed by research on expenditures within the context of preferences and needs of patients and carers.
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Affiliation(s)
- Annicka Gm van der Plas
- 1 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.,2 Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.,3 EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mariska G Oosterveld-Vlug
- 1 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.,2 Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.,3 EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- 1 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.,2 Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.,3 EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- 1 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.,2 Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.,3 EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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de Graaf E, van Klinken M, Zweers D, Teunissen S. From concept to practice, is multidimensional care the leading principle in hospice care? An exploratory mixed method study. BMJ Support Palliat Care 2017; 10:e5. [PMID: 28167657 DOI: 10.1136/bmjspcare-2016-001200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/21/2016] [Accepted: 01/17/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hospice care (HC) aims to optimise the quality of life of patients and their families by relief and prevention of multidimensional suffering. The aim of this study is to gain insight into multidimensional care (MC) provided to hospice inpatients by a multiprofessional team (MT) and identify facilitators, to ameliorate multidimensional HC. METHODS This exploratory mixed-method study with a sequential quantitative-qualitative design was conducted from January to December 2015. First a quantitative study of 36 patient records (12 hospices, 3 patient records/hospice) was performed. The outcomes were MC, clinical reasoning and assessment tools. Second, MC was qualitatively explored using semistructured focus group interviews with multiprofessional hospice teams. Both methods had equal priority and were integrated during analysis. RESULTS The physical dimension was most prevalent in daily care, reflecting the patients' primary expressed priority at admission and the nurses' and physicians' primary focus. The psychological, social and spiritual dimensions were less frequently described. Assessment tools were used systematically by 4/12 hospices. Facilitators identified were interdisciplinary collaboration, implemented methods of clinical reasoning and structures. CONCLUSIONS MC is not always verifiable in patient records; however, it is experienced by hospice professionals. The level of MC varied between hospices. The use of assessment tools and a stepped skills approach for spiritual care are recommended and multidimensional assessment tools should be developed. Leadership and commitment of all members of the MT is needed to establish the integration of multidimensional symptom management and interdisciplinary collaboration as preconditions for integrated multidimensional HC.
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Affiliation(s)
- Everlien de Graaf
- Julius Center for Health Sciences and Primary Care Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Merel van Klinken
- Department of Pain and Supportive Care, Netherlands Cancer Institute Anthoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Danielle Zweers
- Julius Center for Health Sciences and Primary Care Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia Teunissen
- Julius Center for Health Sciences and Primary Care Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
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Abraham S, Menec V. Transitions Between Care Settings at the End of Life Among Older Homecare Recipients: A Population-Based Study. Gerontol Geriatr Med 2016; 2:2333721416684400. [PMID: 28680944 PMCID: PMC5490842 DOI: 10.1177/2333721416684400] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/26/2016] [Accepted: 11/07/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives: Objectives were to (a) describe transitions between care settings in older homecare recipients at the end of life, and (b) examine what personal (e.g., age, sex) and health system factors (e.g., hospital bed supply) predict care transitions. Methods: The study involved analysis of administrative health care data and was based on a complete cohort of homecare recipients aged 65 years or older who died in Manitoba, Canada between 2003 and 2006 (N = 7,866). Results: More than half of homecare recipients had at least one care transition in the last 30 days before death and 21% had two or more hospitalizations in the last 90 days. Both personal characteristics and health system factors were related to transitions and hospitalizations. Discussion: The findings suggest that homecare recipients are an important population to focus on in terms of reducing potentially burdensome transitions and enhancing the end-of-life experience for them and their family.
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Bähler C, Signorell A, Reich O. Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland. PLoS One 2016; 11:e0160932. [PMID: 27598939 PMCID: PMC5012658 DOI: 10.1371/journal.pone.0160932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 07/27/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many efforts are undertaken in Switzerland to enable older and/or chronically ill patients to stay home longer at the end-of-life. One of the consequences might be an increased need for hospitalisations at the end-of-life, which goes along with burdensome transitions for patients and higher health care costs for the society. AIM We aimed to examine the health care utilisation in the last six months of life, including transitions between health care settings, in a Swiss adult population. METHODS The study population consisted of 11'310 decedents of 2014 who were insured at the Helsana Group, the leading health insurance in Switzerland. Descriptive statistics were used to analyse the health care utilisation by age group, taking into account individual and regional factors. Zero-inflated Poisson regression model was used to predict the number of transitions. RESULTS Mean age was 78.1 in men and 83.8 in women. In the last six months of life, 94.7% of the decedents had at least one consultation; 61.6% were hospitalised at least once, with a mean length of stay of 28.3 days; and nursing home stays were seen in 47.4% of the decedents. Over the same time period, 64.5% were transferred at least once, and 12.9% experienced at least one burdensome transition. Main predictors for transitions were age, sex and chronic conditions. A high density of home care nurses was associated with a decrease, whereas a high density of ambulatory care physicians was associated with an increase in the number of transitions. CONCLUSIONS Health care utilisation was high in the last six months of life and a considerable number of decedents were being transferred. Advance care planning might prevent patients from numerous and particularly from burdensome transitions.
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Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081 Zürich, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081 Zürich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081 Zürich, Switzerland
- * E-mail:
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De Vleminck A, Pardon K, Beernaert K, Houttekier D, Vander Stichele R, Deliens L. How Do General Practitioners Conceptualise Advance Care Planning in Their Practice? A Qualitative Study. PLoS One 2016; 11:e0153747. [PMID: 27096846 PMCID: PMC4838248 DOI: 10.1371/journal.pone.0153747] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 04/04/2016] [Indexed: 12/02/2022] Open
Abstract
Objectives To explore how GPs conceptualise advance care planning (ACP), based on their experiences with ACP in their practice. Methods Five focus groups were held with 36 GPs. Discussions were analysed using a constant comparative method. Results Four overarching themes in the conceptualisations of ACP were discerned: (1) the organisation of professional care required to meet patients’ needs, (2) the process of preparing for death and discussing palliative care options, (3) the discussion of care goals and treatment decisions, (4) the completion of advance directives. Within these themes, ACP was both conceptualised in terms of content of ACP and/or in terms of tasks for the GP. A specific task that was mentioned throughout the discussion of the four different themes was (5) the task of actively initiating ACP by the GP versus passively waiting for patients’ initiation. Conclusions This study illustrates that GPs have varying conceptualisations of ACP, of which some are more limited to specific aspects of ACP. A shared conceptualisation and agreement on the purpose and goals of ACP is needed to ensure successful implementation, as well as a systematic integration of ACP in routine practice that could lead to a better uptake of all the important elements of ACP.
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Affiliation(s)
- Aline De Vleminck
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
- * E-mail:
| | - Koen Pardon
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kim Beernaert
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dirk Houttekier
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Robert Vander Stichele
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Heymans Institute, Ghent University, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
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Affiliation(s)
- YongJoo Rhee
- Department of Health Sciences, Dongduk Women’s University, Seoul, Korea
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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West E, Pasman HR, Galesloot C, Lokker ME, Onwuteaka-Philipsen B. Hospice care in the Netherlands: who applies and who is admitted to inpatient care? BMC Health Serv Res 2016; 16:33. [PMID: 26821859 PMCID: PMC4730778 DOI: 10.1186/s12913-016-1273-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background Ten percent of non-sudden deaths in the Netherlands occur in inpatient hospice facilities. To investigate differences between patients who are admitted to inpatient hospice care or not following application, how diagnoses compare to the national population, characteristics of application, and associations with being admitted to inpatient hospice care or not. Methods Data from a database representing over 25 % of inpatient hospice facilities in the Netherlands were analysed. The study period spanned the years 2007–2012. Multivariate regression analyses were performed to study associations between demographic and application characteristics, and admittance. Results Ten thousand two hundred fifty-four patients were included. 84.1 % of patients applying for inpatient hospice care had cancer compared to 37.0 % of deaths nationally. 52.4 % of applicants resided in hospital at the time of admission. Most frequent reasons for application were the wish to die in an inpatient hospice facility (70.5 %), needing intensive care or support (52.2 %), relieving caregivers (41.4 %) and needing pain/symptom control (39.9 %). Living alone (OR 1.68, 95 % CI 1.46–1.94), having cancer (OR 1.40, 95 % CI 1.11–1.76), relieving caregivers (OR 1.18, 95 % CI 1.01–1.38), needing pain/symptom control (OR1.72, 95 % CI 1.46–2.03) wanting inpatient hospice care until death (vs respite care) (OR 3.59, 95 % CI 2.11–6.10), wanting to be admitted as soon as possible (OR 1.64, 95 % CI 1.42–1.88), and being referred by a primary care professional (OR 1.36, 95 % CI 1.17–1.59) were positively associated with being admitted. Wishing to die in an inpatient hospice facility was negatively associated with being admitted (OR 0.85, 95 % CI 0.72–1.00). Conclusions This study suggests that when applying for inpatient hospice care, patients who seem most urgently in need of inpatient hospice care are more frequently admitted. However, non-cancer patients seem to be an under-represented population. Staff should consider application based on need for palliation, irrespective of diagnosis.
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Affiliation(s)
- Emily West
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research - Expertise Centre for Palliative Care, VU University medical center, Amsterdam, The Netherlands.
| | - H Roeline Pasman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research - Expertise Centre for Palliative Care, VU University medical center, Amsterdam, The Netherlands
| | - Cilia Galesloot
- Department of Registry & Research, Comprehensive Cancer Centre the Netherlands (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Martine Elizabeth Lokker
- Department of Registry & Research, Comprehensive Cancer Centre the Netherlands (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Bregje Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research - Expertise Centre for Palliative Care, VU University medical center, Amsterdam, The Netherlands
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Pivodic L, Pardon K, Miccinesi G, Vega Alonso T, Moreels S, Donker GA, Arrieta E, Onwuteaka-Philipsen BD, Deliens L, Van den Block L. Hospitalisations at the end of life in four European countries: a population-based study via epidemiological surveillance networks. J Epidemiol Community Health 2015; 70:430-6. [DOI: 10.1136/jech-2015-206073] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/30/2015] [Indexed: 11/04/2022]
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